MEDICARE: NICOLETTE CAROL MIRAGLIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	46TR01275000	NY

General Provider Information

NPI Number	:	1598628729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE CAROL MIRAGLIA

Provider Business Mailing Address
First Line	:	24 TRUMAN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1906
Country	:	US
Telephone Number	:	917-525-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 N WOOD AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-5200
Country	:	US
Telephone Number	:	908-468-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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